Papers - NANASHIMA Atsushi
-
Kai K., Hamada T., Hiyoshi M., Imamura N., Yano K., Nagano M., Kai M., Hidaka T., Shimoda K., Haruyama Y., Kataoka H., Nanashima A.
International Journal of Surgery Case Reports 76 19 - 24 2020.9
Authorship：Last author Language：English Publishing type：Case report Publisher：International Journal of Surgery Case Reports
© 2020 The Author(s) Introduction: Gallbladder involvement in lymphoma is extremely rare, and only 68 cases have been reported in the English literature so far. We experienced a case of diffuse large B-cell lymphoma (DLBCL) of the gallbladder arising 8 years after DLBCL of the right testis. Presentation of case: A 68-year-old man underwent orchiectomy for malignant lymphoma of the right testis pathologically diagnosed as DLBCL 8 years ago. Systemic surveillance incidentally revealed a gallbladder tumour, and elective resection of the gallbladder bed of the liver was performed under a preoperative diagnosis of gallbladder cancer. The histopathological examination revealed DLBCL. At re-evaluation 3 months after surgery, he was diagnosed as having DLBCL involving the stomach. There had been no recurrence for 39 months after chemotherapy and radiation, but he suffered from a poor general condition due to protein-losing enteropathy and died of infection. Discussion: We compiled and analysed reported cases of malignant lymphomas involving the gallbladder in terms of background, symptoms, imaging findings, and prognosis. Compared to MALT lymphoma, DLBCL was significantly more involved in other organs simultaneously or heterochronously (p = 0.004). Conclusion: Gallbladder lymphoma should be added to the differential diagnosis of gallbladder tumours, especially when clinical findings are not consistent with the typical course of gallbladder carcinoma and cholecystitis.
-
Mai Nguyen Nhat Huynh, Yamaguchi Yuya, Choijookhuu Narantsog, Matsumoto Jin, Nanashima Atsushi, Takagi Hideaki, Sato Katsuaki, Tuan Le Quoc, Hishikawa Yoshitaka
ACTA HISTOCHEMICA ET CYTOCHEMICA 53 ( 4 ) 61 - 72 2020.9
Language：English Publishing type：Research paper (scientific journal) Publisher：JAPAN SOCIETY OF HISTOCHEMISTRY AND CYTOCHEMISTRY
Photodynamic therapy (PDT) uses photosensitizer activation by light of a specific wavelength, and is a promising treatment for various cancers; however, the detailed mechanism of PDT remains unclear. Therefore, we investigated the anticancer effect of PDT using a novel phosphorus tetraphenylporphyrin (Ptpp) in combination with light emitting diodes (Ptpp-PDT) in the NOZ human biliary cancer cell line. Cell viability and apoptosis were examined by MTT assay, flow cytometry and TUNEL assay for 24 hr after Ptpp-PDT. MitoTracker and JC-1 were used as markers of mitochondrial localization and membrane potential. The levels of mitochondrial oxidative phosphorylation (OXPHOS) complexes, Bcl-2 family proteins, cytochrome c and cleaved caspase-3 were examined by western blotting and immunohistochemistry. The results revealed that Ptpp localized to mitochondria, and that Ptpp-PDT efficiently decreased cell viability in a dose- and time-dependent manner. JC-1 and OXPHOS complexes decreased, but apoptotic cells increased from 6 to 24 hr after Ptpp-PDT. A decrease in Bcl-xL and increases in Bax, cytochrome c and cleaved caspase-3 were also found from 6 to 24 hr after Ptpp-PDT. Based on these results, we conclude that Ptpp-PDT induces anticancer effects via the mitochondrial apoptotic pathway by altering the Bax/Bcl-xL ratio, and could be an effective treatment for human biliary cancer.
DOI： 10.1267/ahc.20-00002
-
Kubota K., Jang J.Y., Nakanuma Y., Jang K.T., Haruyama Y., Fukushima N., Furukawa T., Hong S.M., Sakuraoka Y., Kim H., Matsumoto T., Lee K.B., Zen Y., Kim J., Miyazaki M., Choi D.W., Heo J.S., Endo I., Hwang S., Nakamura M., Han H.S., Uemoto S., Park S.J., Hong E.K., Nanashima A., Kim D.S., Kim J.Y., Ohta T., Kang K.J., Fukumoto T., Nah Y.W., Seo H.I., Inui K., Yoon D.S., Unno M.
Journal of Hepato-Biliary-Pancreatic Sciences 27 ( 9 ) 581 - 597 2020.9
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Journal of Hepato-Biliary-Pancreatic Sciences
© 2020 Japanese Society of Hepato-Biliary-Pancreatic Surgery Background: The prevalent location and incidence of intraductal papillary neoplasm of the bile duct (IPNB) and invasive carcinoma associated with them have varied markedly among studies due to differences in diagnostic criteria and tumor location. Methods: IPNBs were classified into two types: Type 1 IPNB, being histologically similar to intraductal papillary mucinous neoplasm of the pancreas, and Type 2 IPNB, having a more complex histological architecture with irregular papillary branching or foci of solid-tubular components. Medical data were evaluated. Results: Among 694 IPNB patients, 520 and 174 had Type 1 and Type 2, respectively. The levels of AST, ALT, ALP, T. Bil, and CEA were significantly higher in patients with Type 2 than in those with Type 1. Type 1 IPNB was more frequently located in the intrahepatic bile duct than Type 2, whereas Type 2 was more frequently located in the distal bile duct than Type 1 IPNB (P ' 0.001). There were significant differences in 5-year cumulative survival rates (75.2% vs 50.9%; P ' 0.0001) and 5-year cumulative disease-free survival rates (64.1% vs 35.3%; P ' 0.0001) between the two groups. Conclusion: Type 1 and Type 2 IPNBs differ in their clinicopathological features and prognosis. This classification may help to further understand IPNB.
DOI： 10.1002/jhbp.785
-
総合外科学講座の利点を最大限に活用した局所進行食道癌および下咽頭癌の重複癌に対する拡大サルベージ手術 Reviewed
武野慎祐，七島篤志，前田 亮，石井廣人，古川貢之，中村都英
手術 70 ( 10 ) 1499 - 1504 2020.9
Language：Japanese Publishing type：Research paper (scientific journal)
-
急性虫垂炎を契機に発見された石灰化を伴う14歳男児の結腸印環細胞癌の1例 Reviewed
長友謙三，池田拓人，甲斐健吾，甲斐真弘，田中俊一，七島篤志
日本臨床外科学会雑誌 81 ( 9 ) 1838 - 1848 2020.9
Authorship：Last author, Corresponding author Language：Japanese Publishing type：Research paper (scientific journal)
-
Kawano F., Yonekawa T., Yamaguchi H., Shibata N., Tashiro K., Ikenoue M., Munakata S., Higuchi K., Tanaka H., Sato Y., Hosokawa A., Takeno S., Nakamura K., Nanashima A.
Endocrinology, Diabetes and Metabolism Case Reports 2020 ( 1 ) 20-0064 - 6 2020.8
Authorship：Last author Language：English Publishing type：Research paper (scientific journal) Publisher：Endocrinology, Diabetes and Metabolism Case Reports
© 2020 The authors. A 54-year-old woman was referred to our hospital with a cervical tumor. CT revealed a cervical tumor extending to the upper mediastinum, tracheal deviation and tumor infiltration in the cervical vessels. She was followed-up because no diagnosis of malignancy was made by cytology. However, 2 months later, a CT scan showed enlargement of the tumor and tracheal stenosis, and a surgical biopsy was performed and she was diagnosed with anaplastic thyroid cancer (ATC). The tracheal tube with tracheal stenosis could not be removed due to the rapid growth of the tumor, necessitating management by mechanical ventilation. Due to the difficulty of surgical resection, she was treated with lenvatinib. A lenvatinib solution was made and administered via a nasogastric tube. After lenvatinib treatment, the tumor volume decreased and the tracheal stenosis improved. The tracheal tube was removed and oral intake became possible. She was discharged and received ambulatory lenvatinib therapy. The tumor was significantly reduced in size, but gradually grew and was exposed through the cervical wound 6 months later. Esophageal perforation occurred 10 months after the start of treatment. Lenvatinib was re-administered via a nasogastric tube. Eleven months later, the patient died of massive bleeding from the exposed cervical tumor. Patients with advanced ATC may require management with mechanical ventilation for airway stenosis or with a nasogastric tube for esophageal stenosis and perforation. We experienced a case in which lenvatinib was safely administered via a nasogastric tube while performing mechanical ventilation.
DOI： 10.1530/EDM-20-0064
-
Hamada T., Yano K., Wada T., Imamura N., Hiyoshi M., Kondo K., Nanashima A.
World Journal of Surgery 44 ( 8 ) 2770 - 2776 2020.8
Language：English Publishing type：Research paper (scientific journal) Publisher：World Journal of Surgery
© 2020, Société Internationale de Chirurgie. Background: The role of adjuvant hepatic intra-arterial infusion chemotherapy (HAI) is considered to be a promising option. Methods: We examined treatment effects of adjuvant HAI using cisplatin in 37 hepatocellular carcinoma (HCC) patients with portal vein infiltration (PVI) who underwent hepatectomy in comparison with those in 85 patients who did not. Results: PVI in 89 patients. Increased levels of aspartate transaminase, tumor markers, size and microvessel tumor infiltration (MVI) or cirrhosis, poorly differentiation, non-adjuvant HAI was associated with lower overall survival (p = 0.09). Poor differentiation, MVI and HAI were independently risk factors associated with tumor-free and overall survivals by the multivariate analysis (p < 0.05). Adjuvant HAI tended to show longer survivals in comparison with no-HAI (p = 0.08) and the multivariate analysis revealed significant efficacy of HAI for better prognosis. Conclusion: Adjuvant HAI showed effectiveness on prolonging tumor-free and patient survival in HCC with PVI and is a promising option in the daily clinical practice.
-
Kai K., Hidaka H., Nakamura T., Ueda Y., Marutsuka K., Ikeda T., Nanashima A.
Clinical Journal of Gastroenterology 13 ( 4 ) 538 - 544 2020.8
Authorship：Last author, Corresponding author Language：English Publishing type：Research paper (scientific journal) Publisher：Clinical Journal of Gastroenterology
© 2019, The Author(s). An 86-year-old woman’s stool sample was positive for blood. Computed tomography (CT) showed wall thickening of the ascending colon at the hepatic flexure. Colonoscopy showed near-complete obturation by colon cancer. Since she was asymptomatic, elective surgery was planned. Laparoscopic right hemicolectomy was performed. Histopathological examination showed poorly differentiated carcinoma cells proliferating in a solid pattern with marked lymphocyte infiltration. The diagnosis was lymphoepithelioma-like carcinoma (LELC) associated with Epstein-Barr virus (EBV) infection; however, EBV-encoded small RNA–in situ hybridization was negative. Microsatellite instability was not assessed. The postoperative course was uneventful and she was discharged on the 15th postoperative day. She remains recurrence-free at 2 years after surgery. Past reports note that colorectal carcinomas with dense lymphoid stroma may be related to LELC or medullary carcinoma (MC). Gastrointestinal LELC is rare, with some reports on LELC of the esophagus and stomach. Reports on LELC of the large intestine are very rare. MC of the large intestine is relatively new concept, firstly described in the WHO Classification of Tumours of the Digestive System 3rd Edition in 2000. We herein present a case of lymphoepithelioma-like carcinoma of the ascending colon and relevant case reports about LELC and MC of the large intestine.
-
Hamada Takeomi, Ishizaki Hidenobu, Haruyama Yukihiro, Hamada Roko, Yano Koichi, Kondo Kazuhiro, Kataoka Hiroaki, Nanashima Atsushi
The Tohoku Journal of Experimental Medicine 251 ( 4 ) 303 - 311 2020.8
Authorship：Last author, Corresponding author Language：English Publishing type：Research paper (scientific journal) Publisher：Tohoku University Medical Press
Colorectal cancer is the fourth most common malignancy across the world, and over 50% of patients had colorectal liver metastases (CLM). Activated neutrophils and tumor-infiltrating lymphocytes (TILs) are considered to interrupt progression of primary colorectal cancer; however, immunological host reactions to CLM have not been fully elucidated. We thus aimed to explore the prognostic implication of neutrophil-to-lymphocyte ratio (NLR) in peripheral blood and TILs in resected metastatic cancer tissues of 29 patients with CLM who underwent hepatectomy. To evaluate local immunological responses in CLM, we examined the infiltration of CD66b+ neutrophils and TILs, such as CD8+ T cells, CD45RO+ T cells, and forkhead box P3+ (FOXP3+) T cells. The presence of fewer than 4 tumors (p = 0.0005), the absence of distant metastasis (p = 0.018), adjuvant anti-cancer chemotherapy (p = 0.0013), and elevated NLR over 4.1 (p = 0.026) were found to be significant parameters related to longer survival after hepatectomy. Further, high numbers of infiltrated CD45RO+ T cells in CLM were significantly associated with longer patient survival (p = 0.020). The numbers of CD45RO+ T cells were correlated with those of CD8+ T cells (p = 0.008). The numbers of peripheral blood neutrophils were negatively correlated with those of CD45RO+ T cells (p = 0.038) and of CD66b+ neutrophils (p = 0.008) in CLM. The present data indicate that elevated peripheral blood NLR and high numbers of intratumoral CD45RO+ T cells are predictive of longer CLM patient survival after hepatectomy among current biomarkers.
DOI： 10.1620/tjem.251.303
-
Utility of thoracic cage width in assessing surgical difficulty of minimally invasive esophagectomy in left lateral decubitus position Reviewed International journal
Takeno, S., Tanoue, Y., Hamada, R., Kawano, F., Tashiro, K., Wada, T., Ikenoue, M., Nanashima, A. and Nakamura, K.
Surgical Endoscopy 34 ( 8 ) 3479 - 2486 2020.8
Language：English Publishing type：Research paper (scientific journal) Publisher：Surgical Endoscopy
Background: This study aimed to assess the surgical difficulty of minimally invasive esophagectomy in the left lateral decubitus position for patients with esophageal cancer from the perspective of short-term outcomes, including operation time, blood loss, and morbidity. Materials and methods: The initial 44 consecutive patients with esophageal cancer who underwent minimally invasive esophagectomy were statistically analyzed retrospectively. Thoracic cage area was measured from preoperative computed tomography as a factor affecting the surgical difficulty of minimally invasive esophagectomy, as well as other patient characteristics. Correlations with short-term outcomes including chest operation time, blood loss, and morbidity rate were then examined. Results: In univariate analyses, smaller area of the upper thoracic cage width correlated with prolonged thoracic procedure time (p = 0.0119) and greater blood loss during thoracic procedures (p = 0.0283), but area of the lower thoracic cage showed no correlations. History of respiratory disease was associated with thoracic procedure time (p < 0.0001), but not blood loss. In multivariate analysis, small area of the upper thoracic cage was independently associated with prolonged thoracic procedure time (p = 0.0253). Small upper thoracic cage area was not directly correlated with morbidity rate, but prolonged thoracic procedure time was associated with increased blood loss (p < 0.0001) and morbidity rate (p = 0.0204). Empirical time reduction (p = 0.0065), but not blood loss, was associated with thoracic procedure time. However, area of the upper thoracic cage did not correlate with empirical case number. In multivariate analysis, area of the upper thoracic cage (p = 0.0317) and empirical case number (p = 0.0193) correlated independently with thoracic procedure time. Conclusion: A small area of the upper thoracic cage correlated significantly with prolonged thoracic procedure time and increased thoracic blood loss for minimally invasive esophagectomy in the left lateral decubitus position, suggesting the surgical difficulty of minimally invasive esophagectomy in the left lateral decubitus position.
-
Yamashita Y.i., Aishima S., Nakao Y., Yoshizumi T., Nagano H., Kuroki T., Takami Y., Ide T., Ohta M., Takatsuki M., Nanashima A., Ishii F., Kitahara K., Iino S., Beppu T., Baba H., Eguchi S.
Hepatology Research 50 ( 7 ) 863 - 870 2020.7
Language：English Publishing type：Research paper (scientific journal) Publisher：Hepatology Research
© 2020 The Japan Society of Hepatology Aim: Combined hepatocellular cholangiocarcinoma (cHCC-CCA) is a very rare subtype of primary liver carcinoma; therefore, its clinicopathological characteristics have not yet been elucidated in detail. The aim of the study was to reveal the clinicopathological characteristics and prognostic factors of cHCC-CCA after hepatic resection (HR). Methods: A total of 124 patients who underwent curative HR for cHCC-CCA between 2000 and 2016 were enrolled in this multi-institutional study conducted by the Kyushu Study Group of Liver Surgery. Clinicopathological analysis was performed from the viewpoint of patient prognosis. Results: A total of 62 patients (50%) had early recurrence within 1.5 years after HR, including 36 patients (58%) with extrahepatic recurrence. In contrast, just four patients (3%) had late recurrence occurring >3 years after HR. The independent predictors of early recurrence were as follows: des-gamma carboxyprothrombin >40 mAU/mL (odds ratio 26.2, P = 0.0117), carbohydrate antigen 19–9>37 IU/l (odds ratio 18.0, P = 0.0200), and poorly differentiated HCC or CCA (odds ratio 11.2, P = 0.0259). Conclusions: Half of the patients with cHCC-CCA had early recurrence after HR. Preoperative elevation of des-gamma carboxyprothrombin or carbohydrate antigen 19–9 and the existence of poorly differentiated components of HCC or CCA in resected specimens are predictors of its early recurrence.
DOI： 10.1111/hepr.13507
-
腹腔鏡下修復術を行った左傍十二指腸ヘルニアの1治療経験：術後炎症性浮腫に伴う腸管通過障害に対してステロイド治療が奏効した1例 Reviewed
中尾大伸，河野文彰，田代耕盛，武野慎祐，池田拓人，中村都英，峯 一彦，七島篤志
日本腹部救急医学会雑誌 40 ( 7 ) 905 - 908 2020.7
Authorship：Last author, Corresponding author Language：Japanese Publishing type：Research paper (scientific journal)
-
直腸憩室炎による膀胱瘻に対する腹腔鏡下根治術の1例 Reviewed
濵田朗子，池田拓人，西田卓弘，河野文彰，武野慎祐，七島篤志
日本内視鏡外科学会雑誌 25 ( 3 ) 157 - 162 2020.5
Authorship：Last author, Corresponding author Language：Japanese Publishing type：Research paper (scientific journal)
-
AirSeal was useful in laparoscopic surgery for perforated appendicitis during pregnancy Reviewed
9. Kai, K., Ikeda, T., Ichihara, A., Hamada, R., Nagatomo, K., Matsuzawa, S., Ushijima, J., Sameshima, H. and Nanashima, A.
Case Reports from Society of Laparoendoscopic Surgeons e2020.00008 2020.5
Authorship：Last author Language：English Publishing type：Research paper (scientific journal)
-
Nanashima A, Imamura N, Hiyoshi M, Hamada T, Yano K, Wada T, Kawakami H, Ban T, Kubota Y, Sato Y, Harada K.
Clinical Journal of Gastroenterology 13 ( 2 ) 233 - 239 2020.4
Authorship：Lead author, Corresponding author Language：English Publishing type：Research paper (scientific journal) Publisher：Clinical Journal of Gastroenterology
Intraductal papillary neoplasm of the bile duct (IPNB) is defined as a non-invasive malignancy; however, since there are disparities in its histological diagnosis, the operative strategy for typical IPNB has not yet been established. A 69-year-old male was diagnosed with a bile duct mass lesion at the confluence of the cystic duct by ultrasonography without clinical symptoms. Liver functional parameters and tumor markers were within normal ranges. Computed tomography showed an enhanced tumor with no findings of ductal invasion or node metastasis. The tumor was exposed in the hepatic duct lumen and biopsy via SpyGlass DS cholangiography revealed that it was a low-grade papillary lesion, indicating type 1 IPNB. Under preoperative diagnostic modalities, limited resection of the extrahepatic bile duct with D2 lymphadenectomy was planned and R0 resection was achieved. The postoperative histological diagnosis was type 1 IPNB without node metastasis. The postoperative course was uneventful and a good prognosis is expected at this stage. In the field of biliary surgery, although extended resection is generally performed for bile duct carcinomas, satisfactory limited surgical resection is possible for type 1 IPNB with lower malignant behavior.
-
Nanashima A., Hiyoshi M., Imamura N., Yano K., Hamada T., Wada T., Nishimuta M., Shimizu I., Mizutani Y.
Nuclear Medicine Communications 41 ( 4 ) 320 - 326 2020.4
Authorship：Lead author Language：English Publishing type：Research paper (scientific journal) Publisher：Nuclear Medicine Communications
© 2020 Wolters Kluwer Health, Inc. All rights reserved. Background The indocyanine green retention rate at 15 min (ICGR15) is a gold standard parameter of liver function when deciding on the extent of hepatectomy. However, ICGR15 is influenced by several hepatic conditions. To evaluate auxiliary preoperative liver functional reserve, we examined the clinical significance of modified parameters by blood tests and technetium-99m galactosyl human serum albumin (99mTc-GSA) scintigraphy. Methods We measured liver function parameters, including the hepatic uptake ratio (LHL15) and the blood pool clearance index (HH15) of 99mTc-GSA and their modified formulae [LHL/HH15, LHL minus HH15, and converted ICGR15 (cICGR15) from a preliminary study] in 229 patients, including 18 with biliary obstruction. Results The mean values of LHL15/HH15, LHL minus HH15, and cICGR15 were 1.646 ± 0.295, 0.347 ± 0.116, and 13.2 ± 5.3%, respectively. These parameters correlated significantly with other liver functions measured by blood tests except for the bilirubin level (P < 0.05) although the actual ICGR15 level correlated positively with the bilirubin level. The difference of ICGR15 (ICGR15 minus cICGR15) in patients with biliary obstruction tended to be higher in comparison with that in patients without biliary obstruction (P = 0.044). Values of LHL/HH15, LHL minus HH15, and the cICGR15 were not significantly associated with postoperative complications. Conclusion The modified parameters of 99mTc-GSA were useful for evaluating hepatic function in patients with high bilirubinemia due to biliary obstruction. However, it remains difficult to establish a more reliable parameter as a standard hepatic function test instead of ICGR15.
-
Uchihara,T., Yoshida, N., Baba, Y., Nakashima, Y., Kimura, Y., Saeki, H., Takeno, S., Sadanaga, N., Ikebe, M., Morita, M., Toh, Y., Nanashima, A., Maehara, Y., and Baba, H.
World Journal of Surgery 44 ( 3 ) 831 - 837 2020.3
Language：English Publishing type：Research paper (scientific journal) Publisher：World Journal of Surgery
Background: Anatomical esophageal position may affect the short-term outcomes after minimally invasive esophagectomy (MIE). A previous single-institutional retrospective study suggested that the presence of a left-sided esophagus (LSE) made MIE more difficult and increased the incidence of postoperative complications. Methods: The current study was a multicenter retrospective study of 303 patients with esophageal cancer who underwent MIE at six esophageal cancer high-volume centers in Kyushu, Japan, between April 2011 and August 2016. The patients were divided into the LSE (66 patients) and non-LSE groups (237 patients) based on the esophageal position on computed tomography images obtained with the patients in the supine position. Results: Univariate analysis showed that patients with LSE were significantly older than those with non-LSE (69 ± 8 vs. 65 ± 9 years; P = 0.002), had a significantly greater incidence of cardiovascular comorbidity (65.2% vs. 47.7%; P = 0.013), and a significantly longer operating time (612 ± 112 vs. 579 ± 102 min; P = 0.025). Logistic regression analysis verified that LSE was an independent risk factor for the incidence of pneumonia (odds ratio 3.3, 95% confidence interval 1.254–8.695; P = 0.016). Conclusions: The presence of a LSE can increase the procedural difficulty of MIE and the incidence of morbidity after MIE. Thus, careful attention must be paid to anatomical esophageal position before performing MIE.
-
陰圧式一時閉腹デバイス(ABTHERA)の使用経験 Reviewed
宗像 駿，河野文彰，池ノ上実，田代耕盛，森定 淳，金丸勝弘，武野慎祐，中村都英，落合秀信，七島篤志
宮崎県医師会医学会誌 44 ( 1 ) 11 - 15 2020.3
Authorship：Last author, Corresponding author Language：Japanese Publishing type：Research paper (scientific journal)
-
神経線維腫症I型に合併した出血性十二指腸GISTの1手術例 Reviewed
奥野佑介，児嶋一司，金丸吉昌，西田卓弘，河野文彰，七島篤志
宮崎県医師会医学会誌 44 ( 1 ) 6 - 10 2020.3
Authorship：Last author, Corresponding author Language：Japanese Publishing type：Research paper (scientific journal)
-
活動性出血を来した十二指腸異所性膵の1切除例 Reviewed
長友謙三，甲斐真弘，和田 敬，甲斐健吾，旭吉雅秀，七島篤志
宮崎県医師会医学会誌 44 ( 1 ) 20 - 24 2020.3
Authorship：Last author, Corresponding author Language：Japanese Publishing type：Case report